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Author Topic: Consultation with Manish Dhawan and Naveen Talwar  (Read 4986 times)

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Sudheer

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Consultation with Manish Dhawan and Naveen Talwar
« on: March 04, 2016, 05:29:59 AM »

Hi Guys, I was in Delhi last week consulting with Doctors about lengthening. I met Manish Dhawan and Naveen Talwar. I'm confused which option to with, and need your suggestions.

Consultation with Manish Dhawan -

He took me to an empty room and asked me to remove my trousers and walk. He suspected that I might have bow legs and asked me to go get an X-Ray. Once he examined the X-Ray, he said that I have slight bow legs and cannot perform LON as the bow leg would prevent it. He said I need to go with TSF to correct the bow leg. He said he would do plating post lengthening if I don't want to wear the frames during consolidation. Lengthening limit is 7 cms. Total cost using TSF would come to around 12 lacs in Rupees, or about 20k in USD.


Consultation with Naveen Talwar -


I met him at his clinic in Defence colony. He said he doesn't recommend to lengthen Tibia. Instead, he recommended to go with Femur lengthening using monorail. He said safe limit is 6 - 8 cms, and if I want more he do 10cms. He referred me to a different doctor (Dr. Bedi) in Fortis hospital in Vasant Kunj.

I met Dr. Bedi next day. What I heard from him is quite contrary to Talwar's suggestion. He examined my joints, muscle stiffness and said femur lengthening is not advisable for me because I'm very muscular. He said the safe limit for me is 3.5 cms in Tibia. He told that they use monorail for lengthening, and plating post distraction. If my body permits, he said he can do 5cms, but he said I shouldn't aim above 5cms.

I asked if monorail is a good option for me due to the bow legs. He said I have slight misalignment and it can be fixed during the surgery. I then called Talwar and explained everything. I asked him to check with Dr. Bedi and provide his final thoughts, and said I'll call in the evening.

In the evening, Dr Talwar said that Dr. Bedi is right and I would have to do Tibia. He also said that he wants to do 7-9 cms on me, instead of 3.5 cms suggested by Bedi, as I'm too short (my height is 5'4''). He said that he would perform achilles tendon lengthening, which can give me the muscle flexibility to go 7-9 cms. I asked him about the bow legs and he said that normally he wouldn't do anything to it as there is not much bowing. However, if I insist, he said he can add an extra pin to the monorail and fix the bow legs during lengthening. Cost of the procedure is around 5 lacs in Rupees or about 10k USD.


My Questions:-
I want to go with Talwar because monorail is very comfortable as compared to TSF ring. However, I'm having trouble believing that monorail can fix bow legs, by adding an extra PIN.
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ub40

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #1 on: March 04, 2016, 05:39:13 AM »

It seems like Dr Parihar is the one that has the best reviews on this site. He's in India as well and the price range is similar. Why don't you consult with him as well?

People here will advise against any external method for femurs. Personally the internal method hasn't been very impressive based on the results on this site. Most people (not me) will still say that internal femurs are the best way. Absolutely do not consider external for femur
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KiloKAHN

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #2 on: March 04, 2016, 06:00:10 AM »

Hi Guys, I was in Delhi last week consulting with Doctors about lengthening. I met Manish Dhawan and Naveen Talwar. I'm confused which option to with, and need your suggestions.

Consultation with Manish Dhawan -

He took me to an empty room and asked me to remove my trousers and walk. He suspected that I might have bow legs and asked me to go get an X-Ray. Once he examined the X-Ray, he said that I have slight bow legs and cannot perform LON as the bow leg would prevent it. He said I need to go with TSF to correct the bow leg. He said he would do plating post lengthening if I don't want to wear the frames during consolidation. Lengthening limit is 7 cms. Total cost using TSF would come to around 12 lacs in Rupees, or about 20k in USD.

Dr Dhawan said the same thing to me about being unable to do much bone adjustment with LON.

The TSF is expensive to apply. I know Dr Dhawan has access to and is able to use the hexapod for six-axis correction. It does the exact same thing as the TSF but the hexapod struts can be attached to a standard Ilizarov frame and are made locally, so they are far less expensive to apply. I wore the hexapod struts for a few days to correct misalignment after lengthening. You can see what they look like in this post of my Patient Experience: http://www.limblengtheningforum.com/index.php?topic=634.msg18873#msg18873

You should see what he says about using the hexapod and report back his reply. When I was there in 2014 he quoted "approximately $10,000" for hexapod and that's when the exchange rate between INR and USD wasn't as much in our favor. There's no reason you need to shell out more for a TSF in particular, imo.

Edit: Have you asked Dr Dhawan his thoughts on Dr Talwar? I know he knows Dr Talwar personally because Talwar used to work at Sir Ganga Ram Hospital.

Quote
Consultation with Naveen Talwar -

I met him at his clinic in Defence colony. He said he doesn't recommend to lengthen Tibia. Instead, he recommended to go with Femur lengthening using monorail. He said safe limit is 6 - 8 cms, and if I want more he do 10cms. He referred me to a different doctor (Dr. Bedi) in Fortis hospital in Vasant Kunj.

I met Dr. Bedi next day. What I heard from him is quite contrary to Talwar's suggestion. He examined my joints, muscle stiffness and said femur lengthening is not advisable for me because I'm very muscular. He said the safe limit for me is 3.5 cms in Tibia. He told that they use monorail for lengthening, and plating post distraction. If my body permits, he said he can do 5cms, but he said I shouldn't aim above 5cms.

I asked if monorail is a good option for me due to the bow legs. He said I have slight misalignment and it can be fixed during the surgery. I then called Talwar and explained everything. I asked him to check with Dr. Bedi and provide his final thoughts, and said I'll call in the evening.

In the evening, Dr Talwar said that Dr. Bedi is right and I would have to do Tibia. He also said that he wants to do 7-9 cms on me, instead of 3.5 cms suggested by Bedi, as I'm too short (my height is 5'4''). He said that he would perform achilles tendon lengthening, which can give me the muscle flexibility to go 7-9 cms. I asked him about the bow legs and he said that normally he wouldn't do anything to it as there is not much bowing. However, if I insist, he said he can add an extra pin to the monorail and fix the bow legs during lengthening. Cost of the procedure is around 5 lacs in Rupees or about 10k USD.

The doctors at Rockland all seem to prefer using monorails, finding them more comfortable for the patient and simpler to apply. But both Dr Dhawan and Dr Parihar advised me against using them.

Dr Dhawan: Said he would not do externals with monorails because you cannot change its axis, whereas with the hexapod everything is under his control. Believes that a good surgeon would not choose to use monorails for cosmetic cases. It was pretty funny because when I asked about using monorails he said "Why do you want to go and f*** yourself?"

Dr Parihar: He has used monorail fixators for lengthening before, but said the disadvantage of using it over the Ilizarov fixators is that there is nothing to hold the foot. With Ilizarov fixators, if you develop trouble in terms of equinus you can use rings to get the foot straight by gradual stretching. With monorails you have nothing to hold the foot. Although monorails superficially look easier, he finds them more complicated than Ilizarov because you have to be absolutely perfect with it, or you can run into other complications. He said that as a general rule, bulkier patients almost always have a tendency to develop valgus deformity with monorails. The monorails are pulling only from one side of the tibia and the monorail doesn't get much of a hold on the soft tissues on the other side, especially with bulkier patients, whereas with ring fixators you've got a hold on both sides. So he much prefers the standard Ilizarov frame for cosmetic lengthening.

Edit: Because the thighs have more muscle surrounding the femur you have a lot more muscle scarring with external femur lengthening, and this risks lots of function like losing the range of motion in your knee. It's also a lot more painful according to those who have done it.

Quote
My Questions:-
I want to go with Talwar because monorail is very comfortable as compared to TSF ring. However, I'm having trouble believing that monorail can fix bow legs, by adding an extra PIN.

I'm no orthopedist, but I'm having a hard time imagining how adding a pin will help fix bow legs. When I had extra pins added they were to increase the stability of the bone. Also, 7-9 cm on tibiae is too much, imo. Others will disagree, though.
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

Sudheer

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #3 on: March 04, 2016, 07:02:22 AM »

Thanks KiloKhan for the responses. Please see my responses below.

With Manish Dhawan  -

Yes, I asked Dhawan about Hexapod. He said it's obsolete and no longer used. That's why he insists that TSF is the only option. He's against standard Illizarov because TSF provides accurate correction.


With Talwar
Yea, 7-9 cms is too much. I said 6 cms is all I want, and if I'm not satisfied I might consider a second lengthening. Talwar had a successful case with morail femur last year. That person has increased 6 cms and was able to walk normally after 7 months without any support!! He goes with LATN using monorail for femur, so he said that that the nail would provide weight bearing after 2-3 months of consolidation. This is what makes me inclined towards Talwar - because he has successful case with monorail. Also, the consultation with Talwar and Bedi felt more professional. I was given enough attention, and all my queries were listened and clearly clarified.

With Dhawan however, there were lot of people waiting outside and the room was open during consultation, and people come in and out during consultation (I had to hide behind the curtain with pants off, while Dhawan was speaking to other patients.. felt awkward :P), and the place it very unhygienic.
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KiloKAHN

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #4 on: March 04, 2016, 07:13:44 AM »

Thanks KiloKhan for the responses. Please see my responses below.

With Manish Dhawan  -

Yes, I asked Dhawan about Hexapod. He said it's obsolete and no longer used. That's why he insists that TSF is the only option. He's against standard Illizarov because TSF provides accurate correction.


With Talwar
Yea, 7-9 cms is too much. I said 6 cms is all I want, and if I'm not satisfied I might consider a second lengthening. Talwar had a successful case with morail femur last year. That person has increased 6 cms and was able to walk normally after 7 months without any support!! He goes with LATN using monorail for femur, so he said that that the nail would provide weight bearing after 2-3 months of consolidation. This is what makes me inclined towards Talwar - because he has successful case with monorail. Also, the consultation with Talwar and Bedi felt more professional. I was given enough attention, and all my queries were listened and clearly clarified.

With Dhawan however, there were lot of people waiting outside and the room was open during consultation, and people come in and out during consultation (I had to hide behind the curtain with pants off, while Dhawan was speaking to other patients.. felt awkward :P), and the place it very unhygienic.

I think you should e-mail Dr Parihar and tell him what Dr Dhawan told you about the hexapod and see what he has to say about it. His response about that seems odd to me. You may want to consult with Dr Parihar in person anyway, even if you don't plan on lengthening in Mumbai currently. Might help you in your decision about whether to go with Dhawan or Talwar.
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

Nightwish

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #5 on: March 04, 2016, 10:39:46 AM »

I'm getting instant red flags from Dr Talwar.

- Not convinced by his indecisiveness over which segment to lengthen.
- He suggests 7-9cm on tibias... Just no.
- Achilles lengthening, just have a read of CrimsonTide's diary, if that doesn't put you off...

I'm not sure anyone here is qualified to know about whether a monorail can fix bow legs, I certainly think it's worth asking a different dr (Dr Parihar) for a second opinion.
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Sudheer

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #6 on: March 04, 2016, 12:00:13 PM »

Thank you Kilokhan and Nightwish

I emailed my Xrays to Dr. Parihar and asked if monorail can fix bowlegs if an extra pin is added. He confirmed that I do have mild varus (bow legs), and he said he doesn't use monorail to fix alignment, and every doctor has their own view/opinion.
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Sudheer

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #7 on: March 04, 2016, 02:52:08 PM »

@Kilokhan - Let's say I go with Manish Dhawan. He agreed to do plating if I don't want to wear the frames for entire consolidation. Could you let me know if plating is a good option or has any downsides. Does it allow weight bearing of some kind at least after 3 months of consolidation ?
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KiloKAHN

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #8 on: March 04, 2016, 07:26:32 PM »

From what I've been told, plates
-help add stability (not as much as a nail though)
- avoids knee pain risk with LON
- reduces fixation time
- cause some more scarring and an increased risk of infection

When I had my consultation with Dr Parihar I did ask him about doing plate fixation because I wasn't keen on externals but was worried about LON, and he told me that he's not a fan of plate fixation. Basically said that it's best for doing it in young children or on only one leg for injuries, but he's against doing it bilaterally in adults for CLL and doesn't think you'd heal well with it. But I have spoken to other doctors who think plate fixation is a perfectly fine alternative to LON. If Dr Dhawan is comfortable with it, you'll save yourself a lot of mental exhaustion you'll get wearing externals for so long.
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Initial height: 164 cm / ~5'5" (Surgery on 6/25/2014)
Current height: 170 cm / 5'7" (Frames removed 6/29/2015)
External Tibia lengthening performed by Dr Mangal Parihar in Mumbai, India.
My Cosmetic Leg Lengthening Experience

Sudheer

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #9 on: March 04, 2016, 07:54:04 PM »

Thanks Kilokhan, as always, for the valuable information.

I now feel that going with Dhawan is a safer option. Let me double check with him on the pricing and see if he can use Hexapod. I don't hink Hexapod is unavailable in the market, as every patient who has deformity problems in India can't afford TSF.
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Sudheer

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #10 on: March 09, 2016, 12:58:09 PM »

Does anyone know if plating supports early weight bearing during consolidation ? Let's say I get my frames removed post distraction. I know that plating doesn't support weight bearing right away, so I have to wait until by bone regenerates before I can start walking. However, I want to know for how long I have to wait before I start weight bearing ? Can I start walking with crutches after 3-4 months of consolidation ? I know that my bone will not be consolidated till then, but If I cannot weight bear until by bone fully regenerates, that would take up to 7-8 months. Does that mean I have to stay bed ridden for 7-8 months ?
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dean9191

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #11 on: October 08, 2017, 03:10:54 AM »

hey did you go with dr.dhawan?
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onemorefoot

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #12 on: October 08, 2017, 04:25:40 AM »

I Wouldnt go to any doctor in India that is not Dr Parihar, why dont you go to him? Dont put in risk with another guy
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MirinHeight

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #13 on: October 09, 2017, 06:51:58 AM »

I Wouldnt go to any doctor in India that is not Dr Parihar, why dont you go to him? Dont put in risk with another guy

I would go to dr. Parihar in a heartbeat if he worked at a place that actually looked like a hospital. I know the language, from US so its not that expensive. But have you seen the hospital? It looks like its from the early 1900s

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currently 179 cm with a 6'2 wingspan
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top 5 LL surgeons: Paley, Rozbruch, Mahboubian,  Donghoon Lee, Giotikas

- planning to have LON tibias with dr donghoon lee in summer 2021

MirinHeight

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #14 on: October 09, 2017, 06:56:32 AM »

.
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currently 179 cm with a 6'2 wingspan
Goal: 182-183
top 5 LL surgeons: Paley, Rozbruch, Mahboubian,  Donghoon Lee, Giotikas

- planning to have LON tibias with dr donghoon lee in summer 2021

onemorefoot

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Re: Consultation with Manish Dhawan and Naveen Talwar
« Reply #15 on: October 09, 2017, 03:55:32 PM »

I would go to dr. Parihar in a heartbeat if he worked at a place that actually looked like a hospital. I know the language, from US so its not that expensive. But have you seen the hospital? It looks like its from the early 1900s
Many users have gotten away becuase of that, but you would be only 7 days there, after you go home. Manish isvnot bad, just be careful during the process
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